Module 37

ACEs Awareness & Prevention Sheet

Understanding Adverse Childhood Experiences and building protective factors

What Are ACEs?

Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur before age 18. The landmark 1998 CDC-Kaiser ACE Study of over 17,000 adults found a strong dose-response relationship between ACE exposure and negative health outcomes decades later. Higher ACE scores are associated with increased risk for heart disease, diabetes, depression, substance abuse, and early death. But ACEs are not destiny — protective factors can buffer their effects significantly.

The 10 ACE Categories

The original ACE questionnaire measures 10 types of adversity in three domains. Each category present before age 18 adds one point to the ACE score (range 0-10).

Domain	Category	Description
Abuse	1. Physical abuse	A parent or adult in the household hit, beat, kicked, or physically harmed you
Abuse	2. Emotional abuse	A parent or adult swore at you, insulted you, humiliated you, or acted in a way that made you afraid of physical harm
Abuse	3. Sexual abuse	An adult or older person touched you sexually, had you touch them, or attempted or completed intercourse
Neglect	4. Physical neglect	You didn't have enough to eat, had to wear dirty clothes, had no one to protect you, or your parents were too impaired to care for you
Neglect	5. Emotional neglect	No one in your family made you feel important, special, loved, or your family didn't look out for each other or feel close
Household dysfunction	6. Domestic violence	Your mother or stepmother was pushed, grabbed, slapped, hit, kicked, or threatened with a weapon
Household dysfunction	7. Substance abuse in household	A household member was a problem drinker, alcoholic, or used street drugs
Household dysfunction	8. Mental illness in household	A household member was depressed, mentally ill, or attempted suicide
Household dysfunction	9. Parental separation/divorce	Parents were separated or divorced
Household dysfunction	10. Incarcerated household member	A household member went to prison

Important

The original 10 ACEs don't capture all adversity. Expanded ACE research also includes: community violence, racism/discrimination, bullying, foster care, poverty, loss of a sibling or close friend, and serious medical procedures. These matter too.

ACE Score & Health Outcomes

Research consistently shows a graded relationship — the higher the ACE score, the greater the risk. However, ACE scores are not predictive for individuals; they describe population-level risk.

ACE Score	Key Statistics
0	Baseline risk. About 36% of adults have an ACE score of 0.
1	About 26% of adults. Slightly elevated risk across categories.
2-3	About 25% of adults. Notably increased risk of depression, smoking, STIs.
4+	About 12.5% of adults. 4-12x increased risk of suicide attempt, substance abuse, depression. 2-3x risk of heart disease, cancer, lung disease. 20-year reduction in life expectancy in some studies.

The Science: Toxic Stress vs. Tolerable Stress

Tolerable Stress (Normal)

✓Brief activation of stress response
✓Buffered by a supportive adult
✓Child returns to baseline quickly
✓Examples: starting school, minor injury, family argument that resolves
✓Builds resilience when well-supported

Toxic Stress (Harmful)

✗Prolonged, severe, repeated activation
✗No buffering adult present
✗Stress response stays elevated chronically
✗Examples: ongoing abuse, neglect, household chaos without support
✗Disrupts brain architecture, immune function, stress response calibration

The key variable is not the event itself but whether a buffering, responsive adult is present. The same event can be tolerable stress (with support) or toxic stress (without it).

Protective Factors: What Parents Can Do

Protective factors don't erase ACEs, but they significantly reduce their impact. Research shows that children with high ACE scores AND strong protective factors can have outcomes comparable to children with low ACE scores.

At the Child Level

Strong relationship with at least one stable, responsive adult— The single most powerful protective factor across all ACE research. It doesn't have to be a parent — grandparent, teacher, coach, mentor all count.

Self-regulation skills— Teaching children to identify and manage their emotions gives them tools to process stress. See the Coping Strategy Cards tool.

Sense of mastery and self-efficacy— Children who believe they can affect outcomes are more resilient. Build this through age-appropriate challenges with support.

Positive self-identity— Cultural pride, spiritual/faith connection, strengths-based narratives about who they are.

At the Family Level

Stable, predictable home environment— Consistent routines, clear expectations, emotional safety. Predictability is protective even when resources are limited.

Parental mental health support— Parental depression, untreated trauma, and substance use increase ACE risk for children. Getting help for yourself IS protecting your child.

Concrete support in times of need— Access to food, housing, childcare, financial assistance. Poverty is a risk amplifier — removing material stressors is protective.

Knowledge of child development— Parents who understand age-appropriate behavior are less likely to react punitively to normal developmental challenges.

At the Community Level

Social connections (reduced isolation)— Families connected to neighbors, faith communities, parent groups have more support and more eyes on children's wellbeing.

Quality childcare and schools— Stable, responsive caregivers outside the home provide additional buffering relationships.

Access to mental health services— Early intervention for trauma (like TF-CBT or PCIT) can interrupt the ACE-to-outcome pathway.

If You Have a High ACE Score Yourself

Many parents discover their own ACE score while learning about their child's development. This can bring up difficult feelings. A few things worth knowing:

1Your ACE score is not your destiny. Millions of people with high ACE scores lead healthy, connected lives.
2Awareness is itself protective. Parents who understand their own triggers are less likely to pass patterns forward.
3Healing is possible at any age. Neuroplasticity means the brain can rewire relational patterns throughout life.
4Therapy works. Trauma-informed therapy (EMDR, somatic experiencing, IFS) can resolve patterns that willpower alone cannot.
5Breaking the cycle is one of the most powerful things a parent can do. If you're reading this, you're already doing it.